- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.04 / $168.51 / $224.10
| Professional | | $121.04 | $168.51 | $224.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.22 / $172.72 / $252.43
| Professional | | $148.22 | $172.72 | $252.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.12 / $246.78 / $360.62
| Professional | | $167.12 | $246.78 | $360.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.88 / $215.58 / $382.63
| Professional | | $164.88 | $215.58 | $382.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.04 / $168.51 / $224.10
| Professional | | $121.04 | $168.51 | $224.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $237.75 / $351.37
| Professional | | $169.82 | $237.75 | $351.37 |